Republic of the Philippines

Department of Health
SOUTHERN ISABELA MEDICAL CENTER
NURSING AUDIT CHECKLIST

UNIT:
NAME OF STAFF:
QUARTER/YEAR: 4TH QUARTER

CRITERIA POINT REMARKS

SCORE
A. To provide quality and safe delivery of Nursing Care
Services
Informed consent is obtained prior to initiation of care
Vital Signs complete and recorded every 24 hrs
Monitoring sheets are recorded properly and completely
Intake and output records complete
Intravenous Fluid Sheet Complete with date and time
consume and number of bottles
Categorized laboratory results attached according to dates
and referred
Initial assessment documented
Re assessment of patient according to their prioritized needs
at least once every shift
Doctors order properly carried out and verified
All verbal orders and telephone orders are countersigned by
Physicians within 24 hours.
Focus is based on the patients’ needs and problems
Data is related to the focus identified
Intervention is implemented with time indicated
Response is noted if achieved or not
Hand written of staff
All specimen receive by the histopathology / laboratory
All sheets have appropriate headings
Appropriate abbreviation was used
Checks emergency cart before duty starts and replenish
used medicines
Census is updated in the directory and HOMIS
Kardex is updated and complete
Logbook is coded and with headings
Use of patient safety checklist
Reporting incidences of Hospital Acquired Infection
Reporting adverse drug reaction
Referral of critical diagnostic result
Availability and location of fire extinguisher
Proper segregation of waste
Refrigerator is free from foods
High Alert Medication are stored to ensure controlled use

a. To identify patient correctly

FM-NSG-073 REV.0/06.01.2019
 Republic of the Philippines
Department of Health
SOUTHERN ISABELA MEDICAL CENTER
NURSING AUDIT CHECKLIST

Patient identification (at least 2 identifier)

IV tag properly label
Reporting incidences of wrong identification of patient
Wrist tag
Census are updated

b. To administer medication accurately

Medicine written in generic name
Medication is completely written (route, dose, frequency)
Medications given countersigned in the medication record
Feeding record is separate from medication record
Reporting medication error
Action of medicine
Dosage computation

c. To prevent Hospital Acquired Injury

c.1. Patient
Fall Risk Assessment done daily
Reporting incidences of Hospital acquired Injury to patient

c. 2. Nursing Staff
Reporting incidences of Hospital acquired Injury to staff

d. To ensure safe Blood Transfusion (BT) administration

Handling, use and administration of blood and blood products
Returning of blood and blood components

e. To prevent patient developing bedsore during

hospitalization
Reporting incidences of bedsore
Pressure ulcer assessment and prevention

f. To prevent patient IV burn-COMPLICATIONS

Reporting of IV burn

g. Discharge Process

FM-NSG-073 REV.0/06.01.2019
 Republic of the Philippines
Department of Health
SOUTHERN ISABELA MEDICAL CENTER
NURSING AUDIT CHECKLIST

Patients are educated about when and whom to follow up

Alagang Tagubilin form is complete and accurate
Patient satisfaction surveys are given to all discharge patient
Patients’ right and responsibilities are communicated in
writing

AWARENESS OF STAFF (INTERVIEW)

Availability of equipment
Functionality of equipment (Process of reporting if not
functional)
Availability of supplies (Requesting of supply if not available)
Corrective Maintenace interface with EFMU
Requesting of medicine in iHOMIS
CDAS and RIS of High alert medicines
Clinical services offered
Awareness of staff regarding No balance billing
Awareness of staff regarding charging of supplies,
equipments, oxygen and others
Managing Customer complaint

Patient Safety
Endorsement
Addressing errors in diagnostic result

Admission of patients in the ward

Action and responsibilities during Code Red

Diagnostic procedure request

Neurologic Assessment (GCS)

Out on Pass for special procedures
Post mortem care
Pre-operative preparation
Prevention of wrong site, wrong patient procedures
Post-operative Care
Pressure ulcer assessment and prevention
Receiving diagnostic result

FM-NSG-073 REV.0/06.01.2019
 Republic of the Philippines
Department of Health
SOUTHERN ISABELA MEDICAL CENTER
NURSING AUDIT CHECKLIST

Vital signs taking

Discharging of patient

Receiving education about consequences of the patient

decision
Identify specific healthcare needs prior to discharge

ATTITUDE
Punctuality
Grooming (uniform, hair, shoes)
Paraphernalia (Bandage scissor and Penlight)
Support Hospital Programs

ORGANIZATIONAL KNOWLEDGE
MISSION, VISION, Quality Policy, Core Values
QOP , QOPM, Risk Register
CAR
Contingency Plan
DOH Secretary
SPMS / IPCR
Organizational Chart
Job Description
Qualified individuals (PRC, BLS, ACLS)
Data privacy act
Issues arise in the course of providing care was addressed
Conduct meeting every month
Policies of the unit
Unit were guided by manual of operation
All staff were trained every year and certificates are available
Entrance and Exit are clearly and prominently marked
RA 9485 anti-red tape act (Citizens Charter)
RA 6713 (Norms of conduct)

Total Point Score:

FINDINGS:

FM-NSG-073 REV.0/06.01.2019
 Republic of the Philippines
Department of Health
SOUTHERN ISABELA MEDICAL CENTER
NURSING AUDIT CHECKLIST

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Auditee:___________________
Auditor:___________________
Date:_____________________

FM-NSG-073 REV.0/06.01.2019